How funding to curtail Pennsylvania’s heroin crisis became a casualty of budget politics

By |July 27, 2016

After a year that saw overdose deaths spike nearly 25 percent in Pennsylvania, $2.5 million in grants to fight the opioid crisis were lopped from the state budget.

Awkwardly, at least $200,000 had already been spent.

Many of the 24 recipients presumed the state would make good on its promise to fund life-saving naloxone, addiction medication and treatment outreach — this being an overdose crisis at levels unseen in the history of the state. It wasn’t until months later, and weeks after the money was actually cut from the budget in March, that recipients learned it didn’t exist.

“We spent the money...Then we got the word that they couldn’t get the money.”

Under the normal process, grant recipients spend their own money and ask for reimbursement from the state.

“We spent the money,” said Tom Holman, deputy district court administrator in Butler County. “Then we got the word that they couldn’t get the money.”

After receiving a $10,000 naloxone grant, Holman made the assumption several others had. That a grant letter sent in September indicated they should get to work, even as Harrisburg was embroiled in an unprecedented budget stalemate that wouldn’t be resolved for six more months.

Meanwhile, the Pennsylvania Commission on Crime and Delinquency [PCCD], which administered the grants for the 2015-16 fiscal year and scrambled to fund some projects, explained that warnings should have been obvious and that recipients proceeded at their own risk.

“If you notified us that you had spent money, you got a call from us saying, ‘Do not. It does not exist,’” said Matthew Leonard, the commission’s spokesman and assistant counsel.

Cuts in a crisis

It’s no secret that the budget stalemate left nearly anyone relying on state funds fearful that a prolonged impasse would imperil operations. At the same time, state officials and lawmakers were outspoken on the need to reduce the toll of the opioid crisis, though money to do that remained scarce.

Here, it meant life or death.

Overdoses killed nearly 3,400 Pennsylvanians in 2015, with heroin or opioid painkillers detected in 81 percent of deaths, according to the Drug Enforcement Administration.

About $751,000 had been budgeted for grants to allow county governments, hospitals and nonprofits to fund outreach to connect struggling residents to drug treatment, along with $162,000 to purchase the overdose antidote naloxone, which can stop an overdose in mere moments.

Another $1.3 million was budgeted for medication-based drug treatment for incarcerated offenders, including in Allegheny County. The county has the second highest overdose death toll in the state.

Naloxone is a nasal spray that can stop a heroin or opioid overdose if administered in time. Funds for naloxone were scrapped from last year’s state budget. Those grants are still being covered, but roughly $2 million for treatment is still unavailable. (Photo courtesy of NOPE-RI)

Organizations like Prevention Point Pittsburgh saw the grant as an opportunity to expand vital services. The nonprofit focuses on harm reduction and sees the damage of addiction and overdoses firsthand.

“For anybody who expended money under this, they were doing so because of the urgency of the work and wanting to sort of do anything that they could to have an impact,” said Aaron Arnold, Prevention Point’s executive director.

A grant for about $47,000 allowed them to hire a full-time staff member to focus on treatment outreach. But with half the grant spent, and after months of waiting, there was no reimbursement.

Arnold described that as a surprise to them, and seemingly a surprise to the commission.

“Nothing like this has ever happened, ever,” Leonard said, stressing that the commission itself was disappointed. “We’ve never had a situation where the money didn’t come through.”

In official reports early on, Arnold said Prevention Point made it clear to the state that money would be spent nearly immediately on a new full-time staff member.

Meanwhile, the commission appeared to be proceeding with the grant process. Progress reports were called for, Arnold said, and filed. In January, the commission asked the nonprofit to provide supplemental data on its efforts to get individuals to drug treatment.

Then communications were sparse; money didn’t come; and many weeks after the funds were eliminated, word came that the grants had been scrapped.

“It just seemed pretty much outside of the realm of common sense that they wouldn’t be making those commitments,” said Arnold, who puts the blame on lawmakers who eliminated the grants amid rising drug-related deaths.

In the newest budget, an additional $15 million in state funds was added for specialized treatment facilities through the Department of Human Services and more funds were given to the Department of Drug and Alcohol Programs. These grants, however, were not reconsidered.

Fine print

Whether spending money without a final state budget was wise depends on how you read the grant documents, which several organizations provided to PublicSource.

There is a caveat near the bottom of the document, saying funds are dependent on the PCCD receiving “sufficient appropriation” for the fiscal year.

But higher up, the same documents say grants specifically run from July 2015 through this June. Immediately below that is language that says “implementation of the project must commence” within 60 days of the effective start date.

After 90 days, projects can be cancelled if operations aren’t underway.

What’s that supposed to mean?

Derin Myers, the commission’s acting executive director, said he can understand why some recipients started their projects.

To him, it looks like July 1, 2015, was the supposed start date, even though letters didn’t go out until two months later and everything depends on the budget.

“I would have assumed when I got that that it’s tying to the start date of the grant,” Myers said. “That’s how I would have interpreted that. I think that’s the intention.”

In a normal year, spending money would have been no problem. Bills would be submitted, and the PCCD would reimburse costs.

The PCCD said it clearly told recipients about the risks. Several recipients, including those wary of spending money, described the process as anything but clear.

“Once they award the grant, all you have is their award letter, and you’ve got to proceed,” said Holman, who was ultimately satisfied with the process because the grant has been fully funded by the Pennsylvania Chiefs of Police Association.

A few other naloxone grants were funded outright by the PCCD using funds from drunken driving fines, and all remaining naloxone grants are being funded by the Chiefs of Police Association with money it received from the PCCD.

Additionally, the commission prioritized a $280,000 grant to the University of Pittsburgh to maintain its OverdoseFreePA data project and related efforts by the school to assist counties with evidence-based strategies to reduce overdoses.

Grants covered by state funds

Grants not covered by state funds

Ongoing confusion

Even with make-up funds, there’s confusion.

Donna Schuck, chief operating officer of the Evangelical Community Hospital, said she didn’t even realize there was a problem with the funds making the budget.

Did the grant documents confuse her?

No, she said she understood the $10,000 grant depended on the budget, but she said PCCD staff encouraged them to submit for naloxone reimbursement so they would be in line when the money came through.

“I just kept following the process,” Schuck said. “And we kept following the program that we had outlined. So we just did everything according to plan, and we were reimbursed.”

Leonard, however, said that nobody should have been spending money, even if staff was accepting expense reports during the budget stalemate.

Then, on March 28, the budget became law.

It had bad news for grant recipients, yet it took weeks for them to be informed.

While the PCCD was administering the grants, the money would have actually come from the Department of Human Services. When the funds weren’t there, commission staff didn’t initially realize it.

“We didn’t know,” Leonard said. “It did take us some time for us to understand exactly what had happened.”

Stalled treatment

While naloxone grants are being funded, many organizations were not so lucky.

Make-up funds are not currently available for outreach, like the work at Prevention Point, or medication assisted drug treatment, which together account for $2 million in expected funds for 12 recipients. According to the commission, half of those recipients spent nearly $200,000, which has not been reimbursed.

It’s possible that funds could become available, Leonard said, but the commission does not yet have a funding source.

“We are going to work to resolve any outstanding issues with those grants," he wrote in an email.

In Allegheny County, close to $294,000 would have paid for a program to supply medication-assisted drug treatment to county jail inmates.

Marc Cherna, the county’s human services director, described this as potentially life-changing treatment for inmates, who are likely to have addiction problems and would essentially be a captive audience.

Four other counties were awarded similar grants that didn’t make the budget.

Allegheny County held off on spending money, assuming that the budget fight could cause problems. That was based on their cautious assumption, he said, not any warning from the state.

And while the county wasn’t on the hook for prematurely spending money, there’s still the consequence of enduring an overdose crisis in one of the region’s hardest hit areas while the state chopped funds for some of the most effective treatment.

“We never really got off the ground that much,” Cherna said, “because the money didn’t flow.”

As a brutal heroin epidemic sweeps the country, lawmakers in 25 states have responded by making it easier to get an antidote to deadly overdoses.

Pennsylvania’s neighboring states of Delaware, Maryland, New Jersey, New York and Ohio already have expanded access to the opioid anti-overdose drug naloxone, also known as Narcan. Their hope: That making it more widely available will mean fewer deaths from heroin overdoses.